Thursday, March 23, 2017

Once upon a time (May – August 2013), I did an elimination diet that had me eating, oh, maybe 20 different foods. I thought if I changed my diet and only ate nutritious, whole foods and avoided the ones that I had sensitivities to, my UC symptoms would get better. Unfortunately, these diet changes did absolutely nothing (if anything I got worse), but I discovered some new-to-me foods and ways to cook them that are actually quite delicious, including roasted fennel, which is still a favorite. I actually geek-out when I see it on the Whole Foods salad bar. Ha!

Anyway, a DTFN client and I were recently chatting about fennel (I love my job), so I decided to create a tasty side dish for our database. I came up with Parmesan Roasted Fennel, which is super easy to make and, holy cow, delicious. I mean, everything tastes better with a little cheese, right? I hope you guys enjoy this recipe!

Ingredients:

2 large fennel bulbs (approx. 20 ounces)

1 tbsp extra virgin olive oil

1/4 cup grated Parmesan

salt + pepper to taste

Directions: Preheat oven 375 degrees. Slice fennel bulbs into three thick slices. (My vegan friend refers to them as “steaks.”) Place them on a lined baking sheet and then brush with olive oil. Sprinkle Parmesan, salt, and pepper on top and then bake for 30 minutes or until tops are lightly browned. Remove from oven and eat!

Autoimmune diseases really throw the body for a loop. You’re attacking your own tissues. Your inflammation is sky high. What’s usually good for you—like boosting the immune system—can make it worse. You’ll often restrict eating certain foods that, on paper, appear healthy and nutrient-dense. You take nothing for granted, measure and consider everything before eating or doing it. Sometimes it feels like almost everything has the potential to be a trigger.

Is it true for exercise, too? Must people with autoimmune diseases also change how they train?

First things first, exercise can help. You just have to do it right, or risk incurring the negative effects.

Don’t overtrain. Most autoimmune diseases are characterized by chronic inflammation. Anything that increases that inflammatory load, like too much exercise, will contribute. Overtraining—stressful exercise that you fail to recover from before exercising again—will increase your stress load and increase autoimmune symptoms.

Yet not exercising might be even worse because exercise increases endorphins. Most think of endorphins purely as “feel-good” chemicals. They’re what the body pumps out to deal with pain, as a response to exercise, and it’s through the endorphin receptor system that exogenous opiates work. Endorphins also play an important role in immune function. Rather than “boost” or “diminish” it, endorphins regulate immunity. They keep it running smoothly. Without endorphins, the immune system begins misbehaving. Sound familiar?

Low-dose naltrexone is a promising therapy for multiple sclerosis and other autoimmune diseases. It works by increasing endorphin secretion, which in turn helps regulate the immune system’s misbehavior. I won’t posit that exercise is just as effective as LDN, but it’s certainly a piece of the puzzle.

This is the same relationship everyone has with exercise. Too much is bad, too little is bad, recovery is required, and intensity must be balanced with volume. The margin of error is just smaller when you have an autoimmune disease.

How should you exercise, then?

It depends on what type of autoimmune condition you have. Let’s explore some of the more common ones.

What works:

Yoga works. A survey of RA patients found that many benefit from regular yoga practice. Another study found that it reduced pain, improved function, and increased general well-being in RA patients.

Light and very light intensity works. One study found that around 5 hours of “light and very light” intensity activity each day were often more effective at improving cardiovascular health in RA patients than 35 minutes of moderate intensity training each day. This isn’t necessarily unique to RA, as I think everyone’s better off walking and moving for 5 hours versus jogging for 30.

What works:

Both strength and endurance training work better than either alone. A 24-week lifting and endurance program has been used to increase BDNF in MS patients. A 12-week lifting and high-intensity interval program improved glucose tolerance in MS patients.

Lifting in the morning works. A recent study found that MS patients had more muscle fatigue and less muscle strength in the afternoon compared to the morning. Muscle oxidative capacity—the ability to burn fat during low level activity—did not differ between times.

Intense exercise works: The greater the intensity, the more BDNF you produce. That’s a general rule for everyone, and it’s no different for MS.

Crohn’s Disease

In Crohn’s, the body attacks the GI tract. It’s a bad one. Because Crohn’s can involve crippling GI pain, impaired digestion, fatigue, joint pain, and emergency diarrhea, patients often avoid exercise. They shouldn’t. If you can get past the mental roadblocks Crohn’s erects, exercise can really help.

What works:

Sprints and medium intensity both work, but sprints are less inflammatory. Both all-out cycling sprints (6 bouts of 4×15 second cycle sprints at 100% peak power output) and moderate cycling (30 minutes at 50% peak power) were well-tolerated by children with Crohn’s, but certain inflammatory markers were higher in the moderate group. Another inflammatory marker also stayed elevated for longer in the moderate group.

Resistance training and aerobic activity both work. Either alone or both in concert improve Crohn’s symptoms by modulating immune function.

Walking works. A low intensity walking program (just 3 times a week) improved quality of life in Crohn’s patients.

Type 1 Diabetes

People often forget about type 1 diabetes, but it’s an established autoimmune disease where the immune system attacks the pancreas and reduces or abolishes its ability to produce insulin. For type 1 diabetics who wish to reduce the amount of insulin they inject, exercise is essential.

It’s also safe, as long as you have your insulin therapy under control.

However, as high-intensity exercise tends to increase blood glucose and easy aerobic exercise decreases it in type 1 diabetics, you really need to have your ducks in a row. The Lancet Diabetes and Endocrinology journal recently published their consensus guidelines for safe exercise with type 1 diabetes, with the main takeaway being that diabetics should monitor their glucose levels before, during, and after training to ensure the numbers don’t get away from them. One study found that quickly giving a dose of insulin following high-intensity training counteracted the rise in blood glucose.

What works:

Combining resistance training with aerobic training works. The combination lowered insulin requirements and improved basically every marker of fitness, along with general well-being.

Resistance training works. In one study, resistance training seemed to lower blood glucose regardless of intensity. However, in one I mentioned above, subjects needed a dose of insulin following high-intensity resistance training to keep glucose under control. “Lift, but watch your glucose” appears to be the safe path forward.

Those are four of the most common and well-studied autoimmune diseases. Others may not have the same rich body of literature, but exercise probably helps there, too.

Graves is an autoimmune hyperthyroid condition. Instead of underactive thyroids, Graves patients have overactive thyroids. There aren’t many trials on exercise in Graves patients, but there are some case studies that suggest some dangers.

In 2012, a Graves patient ended up with rhabdomyolysis (a terrible condition where you break down and pee out muscle tissue) after a non-strenuous exercise session.

Because they’re so trepidatious about it and inactivity numbers are higher than the general population, most autoimmune disease patients would be better served with more exercise, not less. Autoimmune disease patients who loyally read MDA and other ancestral health blogs, however, might be the type to engage in CrossFit WODs and train really hard and rather excessively. If so, you might need less exercise, not more.

As I read the literature, autoimmune disease patients should be exercising in accordance with Primal Blueprint Fitness, albeit even more strictly:

Lift heavy and go intense, but keep it really brief. Low-volume, high-intensity. Short sprints, 3-5 rep sets, that sorta thing. Intensity is relative, so don’t think you have to squat your own bodyweight right away.

Spend most of your training currency on long, slow movements. Hikes, walks, gardening, gentle movement routines are your best friends. Basically anyone with an autoimmune disease can do these activities, and they always help.

Mobility training is required, especially in autoimmune diseases that affect the joints and connective tissues. If your joints are compromised, your other tissues have to be that much more limber, loose, and mobile. Try for something like VitaMoves or MobilityWOD.

Having an autoimmune disease doesn’t make you fragile. You can still train, and evidence shows that you can probably go harder than you think—provided you allow for ample recovery and keep a lid on how much training volume you accumulate.

Anyway, that’s my take on all this. I don’t have an autoimmune disease, though, so I’m only going on what the literature says. I’d love to hear from people who deal with autoimmune disease on a personal level. How do you exercise? What works? What doesn’t? What have you learned along the way?

Remember five years ago, when I was making waffle stacks for breakfast? I recently passed by some waffles in the grocery store and thought maybe Mazen would like them. Of course he doesn’t (he is so weird!), so I’ve been eating them instead.

Instead of a stack, I made a more portable sandwich filled with a peanut butter “frosting”. It was darn good!

I used these waffles:

I mixed in some peanut butter powder with Greek yogurt to make the thick, flavored frosting. Peanut Butter & Co sent me this back in the fall and it’s taken me a while to try it, but now that I have, I’m using it on everything! Obviously I am not afraid of the fat in regular peanut butter. I like that the ingredient list on this is simple, and you can much more easily stir some powder into yogurt or a smoothie than you can thick, sticky peanut butter. So it’s been great for flavor.

In fact, it makes the perfect ingredient to sprinkle into overnight oats!

And I love the hint of vanilla nut in a smoothie bowl. This guy was made of mixed berries, banana, PB powder, milk and spinach. A not-so-green monster!